1. Extended National ICT Research Directors Forum meeting
on European Large Scale Actions (ELSA)
ICT for Health
Dr Dipak Kalra
Dr Dipak Kalra
University College London
University College London
d.kalra@chime.ucl.ac.uk
d.kalra@chime.ucl.ac.uk
on behalf of an panel of experts convened to consider
on behalf of an panel of experts convened to consider
ELSA priorities for ICT solutions for sustainable health
ELSA priorities for ICT solutions for sustainable health

2. European health systems:
priorities and challenges
• Growing expectations for equity of access, quality
and efficiency, patient empowerment and engagement
• Rising incidence of chronic diseases and increased
complexity of their treatment
• age related: dementia, cancer
• lifestyle related: diabetes, asthma, obesity, ischaemic heart disease
• Growing expectations and concerns about patient safety
• Need for better integration across wellness, health care,
public health, occupational health and social care
• Demographic change
• ageing population is driving up demand for health services
• adverse health worker to patient ratio
• Societal pressure for demonstrable protection of privacy

3. Priorities for reliable state-of-the-art
healthcare to all
• focus on prevention and support of patient self-care
and life style management
• foster translation and utilisation of research results
into clinical practice
• improve chronic disease management: knowledge
driven, longitudinal, across care boundaries, patient
involving
• focus on (close to) home and ambulatory health services
• achieve better integration with between healthcare
services, social care and wellness services
• improve skills shortage: case based and population
based e-learning, advanced simulations and modelling

4. Jennings, Miller, Materna 1997

5. A pan-European Health Infostructure
Wellness
Social care
Fitness Citizen in the
Occupational health
Complementary community
School health
health
rapid bench to bed translation real-time knowledge directed care
Point of care
delivery
Teaching explicit consent
Research
Clinical trials
Continuing care
(within the institution)
Education Public health
Research de-identified implied consent Health care
Epidemiology +/- consent management
Data mining Clinical audit
Long-term shared
care (regional national,
global)

6. Our present-day approach to these challenges

7. Implications and opportunities for
ICT in health
• Manage increasingly complex clinical care
• Connect multiple locations of care delivery
• Support team-based care
• Deliver evidence-based health care
• Improve safety
• reduce errors and inequalities
• reduce duplication and delay
• Improve cost effectiveness of health services
• Enrich population health management and prevention
• Empower and involve citizens
• Protect patient privacy
• Better inform and exploit bio-science research

8. Electronic Health Record - EHR 2.0
Clinical trials,
Decision support,
functional genomics, EHR repositories knowledge management
public health databases
and analysis components
Integrating
information
Date: 1.7.94
Whittington
Hospital
Centring services
Healthcare Record
on citizens
John Smith
Personnel registers, DoB 12.5.46
:
Creating and
security services
using knowledge Mobile devices
Clinical
Clinical devices, applications
instruments Social computing:
forums, wikis and blogs

9. Examples of Health ICT research
enabled by the Framework Programme
• Comprehensive electronic records (EHR)
• requirements, information architectures, clinical data standards, terminology systems,
security - now published as international standards
• BUT now needing to be validated against large scale challenges
• standardised clinical meaning across diverse communities of practice
• cross-border confidentiality protection and de-identification
• pan-European quality assured and certified eHealth interoperability solutions
• Virtual Physiological Human (VPH)
• sophisticated modelling of how body systems and organs behave in health and in
disease, to help optimise treatment decisions
• BUT now needing to be refined through
• linkage with real electronic health records, and real-world clinical data quality
• safety testing for real clinical decisions in varied care settings
• Personal Health Systems (PHS)
• wearable and implanted and near patient monitors, communicating with a central
repository: integrating and alerting whenever needed
• BUT now needing to
• integrate with holistic EHR data
• safely advise on patients with multiple diseases and using multi-vendor PHS products

10. Digital Me
Source: Peter Coveney, UCL

11. Principles for a successful approach
• To focus on a very concrete societal need which can
be addressed by user and experience driven R&D,
innovation and large scale demonstrators leading to wide
deployment
• Special effort to engage payers, clinicians and patients
at every stage in addition to the other (more committed)
stakeholders.
• Major milestone: European infostructure on top of
national eHealth infrastructures (not their duplication!)
• Focus on few applications demonstrating the benefits of
such infostructure and open the way for
regional/national/international developments
• Provision of visible and useful milestones, at regular
intervals

12. Examples of objectives of an ELSA
on eHealth
• Improve the quality and effectiveness of clinical shared
care and facilitate cross border care
• Provide “the right information, in the right place, at the
right time” to health providers and patients while
securing the citizens right to privacy
• Bring into the equation other data relevant to our health
beyond medical information (lifestyle, environment)
• Improve the way clinical research is performed and
facilitate faster translation into clinical practice

13. Emphasising translation
• The EU Health Telematics Framework Programmes
have inspired some of the best health informatics
research on the planet
• But, it has proved difficult for some of the research to be
refined and validated at the scale needed for national or
European adoption
• potential impact has not been realised yet
• market potential is as yet under-recognised
• societal gains and cost savings remain a missed opportunity
• It is now vital to capitalise on proof of concept and SME
level Health ICT research
• ELSA’s have the potential to provide large scale
validation, evidence of what works well, and how to turn
research results into products and daily experience